Number of patients: A typical concierge practice has 300 to 400 patients, vs. 1,000 to more than 4,000 in a regular practice.

How many do it: There are an estimated 10,000 concierge doctors nationwide, vs. 300,000 physicians in regular primary care practices.

Source: The Register

Dr. Thomas Hwang, a Tustin internist, didn't like the way his practice was evolving. Even as his patient load expanded, his take-home pay contracted, and he feared not having enough time to spend with his patients.

So a little over a year ago, he invited them to a big meeting at the Tustin Ranch Country Club, where he explained a new feature of his practice. Patients who agreed to pay a yearly fee of $1,600, beyond their insurance premiums, would enjoy better access to him. That included same-day appointments, real-time telephone availability, quick answers to emailed questions, and an exhaustive two-hour annual physical exam with detailed, personalized follow-up. People who were unwilling or unable to pay the fee could still see him on the same basis as before.

“I knew that if I didn't make a change in my practice, I was not going to be able to do it any more. I was going to have to join a giant group like Kaiser,” Hwang recalls. “So part of it was survival. Part of it, too, was to be able to practice in a way I was comfortable with. I didn't want my practice to be a mill.”

Hwang had decided to join a small but growing movement known as “concierge” medicine, first introduced to his practice about four years earlier by one of his professional partners, Dr. Mario Ficarola.

“The concierge practice has been able to give me some breathing room,” Hwang says. “I have one and a half to two hours a day set aside where I can do things at a more humane pace.”

In concierge medicine, patients pay a fee for a number of extra services – mostly related to access, prevention and peace of mind – that are not covered by their insurance. The practice started to gain attention over a decade ago, and is growing, though it still represents only a fraction of the primary care given across the United States today.

Critics of the practice say it creates inequity between patients who have the disposable income to pay for it and those who do not. Some also argue that, because most doctors with concierge practices have only a fraction of the patient volume that more ordinary practices do, its growth could exacerbate a looming shortage of primary care physicians.

That would only amplify one widely expected impact of Obamacare, the federal health reform law, which many experts believe will aggravate the doctor shortage. The new law is expected to bring an estimated 7 million newly insured Americans into the U.S. health system next year alone – and nearly 30 million over 10 years – putting additional pressure on already-stretched primary care providers.

MORE STRESS, LESS PAY

Proponents and practitioners of concierge medicine note that primary care physicians are already leaving the field in large numbers because of declining pay and the high stress and frustration of large patient loads. If anything, they say, concierge medicine is keeping doctors in practice because of the better financial and professional satisfaction it offers.

“Many of our physicians would have left practice. This is helping physicians extend their careers,” saysAndrea Klemes, medical director of Boca Raton, Fla.-based MDVIP, a national concierge medicine network with about 660 doctors and 200,000 patients nationwide that is owned by Procter & Gamble.

Frank Rose, an internist and cardiologist in Dana Point, joined MDVIP in 2008 after two decades in a more regular, high-volume practice.

“I love medicine and I want to continue to practice it as long as I can, and this is allowing me to do that,” he says. “This is more traditional medicine like Marcus Welby, where you can sit with the patient, they can tell you their issues and concerns. If they have family issues, you can listen to that. You just don't have time in seven to 15 minutes to address those issues.”

The concept is also appealing to many patients – at least those who can afford the fees, which average about $1,500 to $2,000 a year but can go as high as $8,000 or even more in rare cases where doctors care for only a tiny number of individuals or families.

“I know if I've got an issue and I call in, I'm going to see him the same day,” says Edward Barry, 75, who pays $1,600 a year for Dr. Hwang's concierge service. “I'm sure if you talk to somebody with less income, they'll have a different opinion, but I don't view it as a high price for the value I'm getting.”

Peter Gelker pays an annual fee on top of his regular insurance in order to have more access, quicker appointments, and more time with his doctor, Thomas Hwang. ROSE PALMISANO, ORANGE COUNTY REGISTER
Peter Gelker's fee gets him more access to Dr. Thomas Hwang. ROSE PALMISANO, ORANGE COUNTY REGISTER
Peter Gelker pays an annual fee on top of his regular insurance to see Dr. Thomas Hwang. ROSE PALMISANO, ORANGE COUNTY REGISTER
Dr. Gregg DeNicola, the CEO of Caduceus Medical Group, examines patient Scott Hague of Laguna Niguel. DeNicola is not a fan of the concierge model. He says he and his physician colleagues provide many of the same benefits of concierge medicine without charging the extra fee. JEBB HARRIS, ORANGE COUNTY REGISTER
Dr. Gregg DeNicola, the CEO of Caduceus Medical Group, shows off the group's mobile device app. He says he and his physician colleagues provide many of the same benefits of concierge medicine without charging the extra fee. "I think it's ludicrous to charge $2,000 to provide good services. You should provide good customer service because it's the right thing to do," he said. JEBB HARRIS, ORANGE COUNTY REGISTER
Dr. Gregg DeNicola, the CEO of Caduceus Medical Group examines patient Scott Hague of Laguna Niguel. DeNicola is not a fan of the concierge model. JEBB HARRIS, ORANGE COUNTY REGISTER
Medical assistant Kari McDonough takes blood pressure of patient Scott Hague at Caduceus Medical Group in Laguna Beach. JEBB HARRIS, ORANGE COUNTY REGISTER
Caduceus Medical Group in Laguna Beach is decorated with work of local artists such as Scott Hague, who did the koi on this bathroom wall. Dr. Gregg DeNicola, the CEO of Caduceus Medical Group,, is not a fan of the concierge model. He says he and his physician colleagues provide many of the same benefits without the fee. JEBB HARRIS, ORANGE COUNTY REGISTER

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